Current concepts and controversies in the pathogenesis, prevention, and treatment of the macrovascular complications of diabetes

Type 2 diabetes is already a common disease in the United States. It has been estimated that at least 10 million individuals currently have a diagnosis of diabetes in the United States and that another 5 to 6 million have undiagnosed type 2 diabetes. This translates into approximately 6% of the total US population affected by this disease. In addition, prevalence rates for diabetes are predicted to grow substantially over the next several decades. 1 American Diabetes Association Screening for type 2 diabetes. Diabetes Care. 2000; 23: S20-S23 Google Scholar This increase is related to several factors. First, the increasing life expectancy in the United States leads to increased prevalence of diabetes because this disease becomes more common with advancing age. Second, specific subgroups of the American population appear to have a stronger genetic predisposition for type 2 diabetes, including African Americans and Hispanic Americans. These ethnic subgroups are becoming a larger portion of the United States population as a result of a faster growth rate compared with that of the overall population. Third, obesity and physical inactivity are increasing in this country, and both of these are associated with increased prevalence for type 2 diabetes. On the basis of these same factors, one could also predict an increasing prevalence of impaired fasting glucose, impaired glucose tolerance, and insulin resistance over the next several decades.